Individual
IVAN WONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
2000 VIA DEL REY, SOUTH PASADENA, CA 91030-4146
(310) 866-6203
Mailing address
2000 VIA DEL REY, SOUTH PASADENA, CA 91030-4146
(310) 866-6203
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MST-000417
CA
Other
Enumeration date
01/08/2021
Last updated
01/08/2021
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